Head-Shaking or Trauma

Accidental head bumps against cabinets or playful jostling that causes head shaking or injury are often easily overlooked and forgotten. Patients usually seek a neurosurgeon’s help 3 weeks to 3 months after the incident, only then noticing discomfort and discovering traces of head impact or trauma upon examination.

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A clinical analysis of over 200 brain injury patients revealed that half of them did not recall any head shaking or traumatic experiences. Head shaking or impacts are common in daily life, ranging from minor scalp injuries to serious cases that can render a person unconscious, posing life-threatening risks.

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Even if there is no bleeding or visible injury from accidents or falls, it is crucial not to dismiss the need for medical examination and treatment. Clinically, many cases of intracranial bleeding present with no external wounds. If there has been head shaking or impact, patients and their families must pay attention to:

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1. Whether there was a temporary loss of consciousness or partial amnesia at the time of injury.

2. Monitor the injured person's consciousness, which should remain clear for more than three days.

3. Whether headaches and vomiting symptoms are worsening.

4. If there is numbness or weakness on one side of the limbs.

5. Whether the gait is unsteady, could indicate cerebellar injury.

6. During sleep at night, family members should closely monitor and occasionally awaken the brain trauma patient to ensure alertness and prevent sleepiness or unconsciousness due to intracranial bleeding and pressure on the brain.

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Classification of Head Trauma Assessment

The Glasgow Coma Scale (GCS) is a method to assess a patient's consciousness, with a full score of 15 and the lowest being 3. The scoring is based on the patient's eye-opening (Eye), limb movement (Motor), and verbal response, with the total of the three as the GCS score.

Within 20 minutes after head trauma, the patient's consciousness GCS score is:

 

• (A) Mild head trauma GCS score of 13 to 15

• (B) Moderate head trauma GCS score of 9 to 12

• (C) Severe head trauma GCS score of 8 or below

Head Trauma Inspection and Treatment

Computerized Tomography (CT Scan) and Magnetic Resonance Imaging (MRI) is widely used. Particularly, CT scans clearly show various acute intracranial hematomas and brain injuries. Patients with head trauma are given skull X-rays, and those who are unconscious, show neurological dysfunction or are suspected of intracranial hematomas should have a CT scan promptly arranged.

 

Common types of head trauma, symptoms, and complications include:
 

1. Scalp Hematoma:
   After a head impact, it's common for a swelling to arise, resembling the size of an egg and causing pain. Treatment involves no medication, no rubbing, and no heat application; it usually resolves within one and a half months.
    

2. Scalp Wounds:
   Wounds require attention to stop bleeding and maintain cleanliness.
    

3. Headaches:
   The variation in post-traumatic headaches can be significant. Some people experience only mild headaches, while others suffer from unbearable pain. The pain can be persistent, episodic, dull, throbbing like a pulse, burning, or feeling like a pressing weight. The range of headaches can be diffuse or localized to specific areas. Changes in posture, stress, fatigue, or physical strain can often worsen the pain, which can be alleviated by rest or standard analgesics.
    

4. Dizziness:
   Post-traumatic dizziness is usually intermittent, lasting a few minutes each time. Changes in posture or psychological stress can induce dizziness, which can improve when lying down with eyes closed. The frequency and severity of dizziness can vary greatly. Approximately half of those with mild head injuries experience dizziness, and about half of these cases last more than two months. Three-quarters of patients with dizziness also have headaches, and about three-quarters of those with headaches also experience dizziness.
    

5. Concussion:
   A mild concussion refers to the absence of any apparent head injury, but the individual may experience temporary loss of consciousness, hearing, smell, or short-term memory loss, as well as headaches, confusion, blurred vision, unsteady gait, tinnitus, nausea, insomnia, inability to concentrate, emotional distress, and a lack of energy to work. This condition should not be ignored, and seeking medical attention from a neurosurgeon is essential to prevent permanent sequelae.
    

6. Brain Injury:
   Substantial damage to the brain near the impact site, often with intracranial bleeding. In addition to concussion symptoms, severe brain injuries can lead to drowsiness, unconsciousness, seizures, limb weakness, abnormal behavior or personality, and rapid breathing.
    

7. Intracranial Hemorrhage (Brain Hemorrhage):
   Hematomas directly compressing brain tissue can cause headaches, vomiting, rapid breathing, facial or limb convulsions, dizziness, limb weakness, numbness, altered consciousness, drowsiness, and unconsciousness. Immediate medical attention is crucial to prevent permanent disability or life-threatening situations. The most common fatal complications in head trauma cases are subdural or epidural hemorrhages.
    

   • Chronic Subdural Hemorrhage:

     Elderly patients or children, particularly those over 50 years old, may develop "chronic subdural hemorrhage" from incidents such as falling or bumping their head when getting up to use the bathroom at night or from unstable walking. This condition often starts to appear gradually within two weeks after the injury, and some people may not notice symptoms for up to two years. Symptoms can include headaches or unilateral weakness similar to a stroke, memory decline, cerebellar damage causing weakness in both legs, unsteady walking, and a decrease in appetite. However, an imbalance in electrolytes can also cause limb weakness, leading to delayed diagnosis in many elderly. Typically, the incidence of chronic subdural hemorrhage is low, about 1% to 3%. The brain generally absorbs the blood by itself. However, if there is severe bleeding or long-term pressure on the brain stem, and if minimally invasive surgery to drain the hematoma is not performed in time to relieve pressure on the brain, it can lead to respiratory suppression, resulting in permanent disability or life-threatening conditions.
      

   • Epidural Hemorrhage:

     Following an impact on the skull, internal blood vessels can be damaged and bleed. The "dura mater" itself is the outermost tough layer protecting the brain. If the bleeding is not severe, unusual severe headaches may not appear until a few days after the head injury (typically four to five days), and some patients might even be misdiagnosed with "migraine" or "tension headaches." Therefore, patients presenting with headache symptoms should inform their doctors about any head trauma they have experienced to allow for accurate differential diagnosis.
      

8. Brain Laceration and Skull Fractures:
   Direct damage to the tissue, with symptoms similar to brain injury and intracranial hemorrhage.
    

9. Cerebral Edema:
   After brain cells are injured, edema often occurs, leading to central nervous system damage and possibly causing intracranial hemorrhage.
    

10. Cerebral Ischemia:
    Increased intracranial pressure can lead to insufficient blood supply, causing damage or death to brain cells.
     

11. Epilepsy:
    Approximately 2% to 7% of patients with brain injuries may develop epilepsy, especially those with moderate to severe brain injuries, who have a higher probability of developing epilepsy. In such cases, it is necessary to monitor the brain waves for abnormalities and if severe epilepsy is confirmed, anti-epileptic medication may be required to manage the condition.

Precautions for Head Injuries

The first 72 hours after an injury is the most critical observation period, during which patients and their families should pay special attention. If the patient develops any of the following symptoms, they should promptly contact a neurosurgeon or go directly to the hospital for further examination:

 

1. Temporary loss of consciousness or partial amnesia at the time of injury.

2. Severe headache or dizziness.

3. Drowsiness or inability to be awakened (such as gradually diminishing consciousness).

4. Indifference to surroundings, lack of concentration, or changes in personality.

5. Loss of orientation to time and place.

6. Nausea, vomiting, vertigo.

7. Unilateral numbness or weakness in the limbs.

8. Unsteady gait while walking.

9. At night, family members of the brain injury patient should closely monitor and occasionally wake the person to ensure consciousness, to prevent the risk of intracranial bleeding, which can lead to increased pressure on the brain, causing drowsiness or non-responsive coma.